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IBRD and IDA: Working for a World Free of Poverty.enWhy do sanitation campaigns fail?http://blogs.worldbank.org/publicsphere/why-do-sanitation-campaigns-fail
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<img alt="" height="211" src="https://blogs.worldbank.org/publicsphere/files/publicsphere/3220088155_04a48de049_o.jpg" style="float:left" title="" width="280" />The study finds that the govt’s rural sanitation programme, implemented by NGOs, was unable to reduce exposure to faecal matter.</h4>
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A&nbsp;recently published Lancet <a href="http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(14)70307-9.pdf" rel="nofollow" target="_blank">paper</a> looks at the impact of the erstwhile Total Sanitation Campaign in the coastal Puri district in Odisha. The study finds that the government’s rural sanitation programme, implemented by NGOs and community-based organisations, was unable to reduce exposure to faecal matter. As a result, this sanitation programme had no impact on the incidence of diarrhoea and malnutrition. The authors of the paper conclude that in order to realise concrete and sustainable health benefits, sanitation programmes need to increase both the coverage and use of toilets, as well as improved hygienic practices.</div>
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No one denies the importance of good sanitation and the impact it has on human health. It must follow therefore that the lack of positive impact is down to poor implementation of the sanitation programme in the study area. In fact, a <a href="http://www.biomedcentral.com/1756-0500/7/486" rel="nofollow" target="_blank">process evaluation</a> of the programme concludes that the implementation was far from perfect, both in terms of the levels of coverage achieved and the levels of awareness. Over an implementation period of 13 months (January 2011—January 2012), the villages where the programme was implemented saw an increase in toilet coverage from 9% to 63%, but only 38% of the households had a functional toilet. It would have been interesting to learn more about the gap between toilet construction and usage (25 percentage points). In any case, the state of implementation, the authors point out, is typical of the prevalent Total Sanitation Campaign across the country.<br />
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On the one hand, the Total Sanitation Campaign of 2011 morphed into the Nirmal Bharat Abhiyan in 2012 and then, into the much-hyped Swachh Bharat Abhiyan of 2014. On the other hand, the essence of this public programme has hardly changed. An over-reliance on individual household subsidy for toilet construction continues to mark these schemes. The focus on individual households means that sanitation programmes try to move ahead rapidly with those families that are willing and able to construct toilets—much like a housing or livelihoods programme would do. However, it has become amply clear that this approach does not work.</div>
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For one, without total coverage, the gains from improved sanitation cannot be realised in a community. Even before one begins to debate the balance of priorities between sound construction and behaviour change communication, implementers need to acknowledge that sanitation programmes follow an ‘all or nothing’ logic. Unless all families adopt hygienic sanitation practices, we will not make a dent on the incidence of disease prevalence. This is amply demonstrated by the findings from the Odisha study.</div>
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What is also striking is that implementation appears to have stopped at around the 60% mark. The process evaluation in fact shows that between February 2012 and March 2013, the coverage of toilets actually declined. Again, anecdotally, we have seen this happen over and over again. Villages get checked off the list as ‘covered’ when in fact, they lie partially or completely incomplete. This reflects two things: one, the failure to run an effective motivation—hygiene promotion—behaviour change campaign; and two, the failure to ensure construction of decent and usable toilets. From a policymaker’s perspective, it would be impossible to disentangle the two, to identify the real reason for the failure of the programme.
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This brings me back to recent debates around whether sanitation programmes need to be toilet construction-led or behaviour change-led. This evidence from this study supports both camps. But more than either side, it supports the argument that in order to have a successful programme, you need to approach the problem from both sides with equal seriousness.</div>
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Nothing (other than a success story) about India’s Total Sanitation Campaign would be surprising for long-time observers of the water and sanitation sector around the world. This study does, however, contribute a solid piece of evidence, based on rigorous evaluation methods and relatively long observation time-frame, on how public sanitation programmes in India have failed to get it right—so far.<br />
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<em>This post first appeared on <a href="http://www.livemint.com/Opinion/TA4wMBo65o3lsKAxkzJ4EL/Why-do-sanitation-campaigns-fail.html" rel="nofollow" target="_blank">Livemint</a></em><br />
Photograph&nbsp;by indiawaterportal.org copyright of Copyright UNICEF and Govt. of India <a href="https://www.flickr.com/photos/indiawaterportal/3220088155/in/photostream/" rel="nofollow" target="_blank">via Flickr</a>Wed, 25 Feb 2015 14:04:00 -0500Suvojit ChattopadhyayNepal aims to be “open defecation free”http://blogs.worldbank.org/endpovertyinsouthasia/nepal-aims-be-open-defecation-free
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<img alt="The open toilet along the river in Nangkhel village" src="https://blogs.worldbank.org/endpovertyinsouthasia/files/endpovertyinsouthasia/np-blog-odf-1.jpg" style="float:left; height:214px; margin:5px; width:143px" />We rarely give the toilet a second thought.&nbsp;We use it when we need to, and we flush and forget.&nbsp;We are also able to conveniently wash our hands afterwards.&nbsp;But imagine if you are on a long hiking trip or a bus ride with no stops in sight and had no access to a toilet or running water.&nbsp;It’s a situation most people would dread.<br />
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In poorer parts of the world, this is the daily reality for many.&nbsp;The humble toilet—perhaps the most important contributor to improved human health in history—is a luxury item which relatively few people enjoy.&nbsp;Without a toilet, the poor have to go in the open, behind bushes, or next to streams.&nbsp;They cannot flush their waste away or wash their hands afterwards if they wanted to.&nbsp;In poorer countries, managing human waste remains a major challenge, and failure to meet that challenge exposes millions of children and adults to waste-borne diseases that can have deadly consequences.<br />
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In <a href="http://www.worldbank.org/en/country/nepal" rel="nofollow">Nepal</a>, a country of approximately 26 million people, nearly 40% of the population&nbsp;do not have toilets.&nbsp;In parts the <em>Terai</em> or lowland areas, this number climbs to a staggering 75%.&nbsp;To be sure, the Government of Nepal has achieved remarkable progress in improving sanitation coverage in the last two decades.&nbsp;In 1990, only 6%&nbsp;of Nepalis had access to a toilet.&nbsp;By 2011, 62%&nbsp;had access, with the sanitation Millennium Development Goal (MDG) achieved ahead of the 2015 target.&nbsp;However, that achievement still leaves a large population—more than nine million people—without toilets.&nbsp;So the Government decided to aim for a new and more ambitious target—universal access by 2017. And it may get there.<br />
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<img alt="Chaturman and Nyuchemaya outside the new toilet on their back porch" src="https://blogs.worldbank.org/endpovertyinsouthasia/files/endpovertyinsouthasia/np-blog-odf-2.jpg" style="float:right; height:297px; margin:5px; width:198px" />Last month, I visited Nangkhel, a Newari village near Bhaktapur in the eastern corner of the Kathmandu Valley, to see how one village succeeded in bringing the luxury of a toilet to all 181 households (or about 900 people).<br />
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<span style="line-height:1.6em">There I met Chaturman and Nyuchemaya, an elderly, landless couple and one of the poorest family in Nangkhel.&nbsp; They weren’t convinced that they needed a toilet.&nbsp;It was too expensive; the bush was free.&nbsp;Besides, there didn’t seem to be any room for a toilet on the tiny plot that their home occupied!&nbsp;But in the end, Chaturman’s friend, his </span><em style="line-height:1.6em">“dai”</em><span style="line-height:1.6em">, formerly the village chairman and still a member of the village’s WASH committee, convinced them that it was not only good for them, but affordable too.</span><br />
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It took only seven days to build the toilet.&nbsp;The village provided the pan and pipe ($15). Chaturman and his wife dug the pit themselves.&nbsp;And their daughter covered the remaining costs needed to buy the bricks ($16) and cement ($26) and to pay the masons to line the pit and build the shelter ($50).<br />
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The result was a new toilet in an outhouse on their back porch.&nbsp;A neighbor connected a tap to a gravity-fed piped-water system about 10 feet away, and now elderly friends use the tap and the soap placed next to it to wash.<br />
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The elderly couple is clearly proud of their achievement.&nbsp;They used to go near the stream about 200 meters away, but as they aged, they found it increasingly difficult to do so.&nbsp;“I am old, and it is hard to go down to the river. It is far and slippery.&nbsp;But now, even if I get sick,” said Chaturman with a laugh, “I can still crawl to the toilet.”<br />
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What Chaturman and Nyuchemaya did was an inspiration to the village.&nbsp;If the poorest household could build a toilet, there was no longer an excuse for any other villager not to build.&nbsp;And build they did! Within a few months, all other households in the village had built their own toilets—with some that even added a sink or shower in an enclosed structure.<br />
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<img alt="A new toilet in Nangkhel village, with tiles, mirror and showerhead—next to a house without electricity" src="https://blogs.worldbank.org/endpovertyinsouthasia/files/endpovertyinsouthasia/np-blog-odf-3.jpg" style="float:left; height:291px; margin:5px; width:400px" />Helping villages like Nangkhel to become “open defecation free” &nbsp;(ODF) involves partnership.&nbsp;The World Bank helped rural communities to improve their water supply and achieve universal sanitation through the Second Rural Water Supply and Sanitation project, which closed in 2012. The UN supported a similar initiative in another area.<br />
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Young volunteer women helped convince villagers of the importance of using an improved toilet.&nbsp; They focused their campaign on mothers, who quickly learned that containing human excrement reduces sharply the risk of fecal transmission of diseases, including diarrheal disease, a major killer of children.&nbsp; Preparing food or letting children play next to an open sewer has become a thing of the past.<br />
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September 21, 2013 marked an important milestone for all households in Nangkhel and the other villages and municipalities in the district:&nbsp;Bhaktapur was declared ODF. Village by village, city by city, district by district, Nepal aims to be completely ODF by 2017. It is an inspiring example for other countries who want to deliver the same results to their citizens.<br />
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<em>All photographs by Donatella Lorch Copyright 2013</em><br />
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Thu, 19 Dec 2013 08:48:00 -0500Johannes ZuttA Basic Need to Help Childrenhttp://blogs.worldbank.org/water/basic-need-help-children
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<em>Alassane Sow, World Bank&nbsp;Country Manager for Cambodia, and Rana Flowers, UNICEF Representative to Cambodia, wrote an op-ed for The Phnom Penh Post. </em><em>Read the op-ed below, <a href="http://www.phnompenhpost.com/analysis-and-op-ed/basic-need-help-children" rel="nofollow" target="_blank">courtesy of The Phnom Penh Post</a></em>.</p>
Did you know that in communities where a high proportion of people defecate outdoors, children are on average shorter than children living in communities where most people use toilets?<br />
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New research in Cambodia conducted jointly by the World Bank’s Water and Sanitation Program and the Research Institute for Compassionate Economics (RICE) shows that open defecation contributes significantly to stunting of children.<br />
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In layman’s term, <a href="https://wsp.org/sites/wsp.org/files/publications/Growing-Tall-and-Smart-with-Toilets-Research-Brief.pdf" rel="nofollow" target="_blank">the study led by Dean Spears</a>, a researcher on health and needs of young children in poor countries, found that a 5-year-old child living in a community where everyone uses a toilet would on average be 2cm to 3.6cm taller than the child living in a community where no one uses a toilet.</p>
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More importantly, open defecation not only affects one’s own health, but it also affects the health of one’s neighbours. In other words, when almost an entire community is defecating in the open, even the children in families that use a toilet are almost as short as the children in families that do not use a toilet. Simply put: toilets make good neighbours.</p>
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Does this small difference in height matter? Yes it does, because children are not making up for this height loss in their early years and as a result will not achieve their full cognitive potential.</p>
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Long-term research studies following individuals in the US and the UK have shown that taller children are more likely to become taller adults, and taller adults are more likely to earn more income, as pointed out by professors at Princeton University Anne Case and Christina Paxson in their research.</p>
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<a href="http://blogs.worldbank.org/water/ending-open-defecation-not-by-evidence-alone" rel="nofollow">Another study by Dean Spears</a> highlights that in places like India, taller children are much more likely to be able to read and do mathematics.</p>
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Therefore, any linkage between sanitation and child height reveals that exposure to open defecation can be a serious barrier for children growing into tall, smart and ultimately productive adults.</p>
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This means that tackling open defecation deserves the focused attention of policy makers to address malnutrition, like other essential interventions such as breast-feeding, nutrition intake and basic access to health care services for mother and child.</p>
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Although Cambodia’s economic growth has been impressive, averaging 8.2 per cent during the period 2000 to 2010 – the 15th fastest in the world – the country is still among those with the highest rates of open defecation.</p>
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In 2010, 57 per cent of Cambodian families still defecated openly, and this rate is even higher in rural areas at 66 per cent. At the same time, malnutrition indicators, such as stunting among under-five-year-olds remain high at 40 per cent in 2010.</p>
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The situation is even worse among poor families which are three times less likely to have access to good sanitation facilities than the average, according to the forthcoming Cambodia Poverty Assessment 2013.</p>
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The Royal Government of Cambodia recognises this challenge and has set itself the goal of reaching universal rural sanitation coverage by 2025, a target that, to be achieved, requires a rate at least six-times higher than past annual progress.</p>
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By declaring November 13 National Sanitation Day, the government aims to garner support for the sanitation sector and to promote sanitation awareness, particularly among rural communities.</p>
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The theme for this year was “Better Sanitation Starts with You,”&nbsp;recognising the importance of empowering communities and local leaders to take action and improve everyone’s sanitation situation.</p>
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The celebration of National Sanitation Day in Cambodia is in tandem with the first United Nations designated <a href="http://worldtoiletday.org/" rel="nofollow" target="_blank">World Toilet Day</a> on November 19.</p>
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Appreciating the importance of reducing open defecation to improve a child’s nutritional status, more needs to be done to accelerate <a href="http://www.worldbank.org/en/news/feature/2013/08/30/whats-a-toilet-worth-infographic" rel="nofollow" target="_blank">access to sanitation</a> in the country, in close collaboration with nutrition-specific interventions.</p>
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Research shows us that sanitation policies would best prioritise community-wide behaviour change to stop open defecation. Incentives, policies and targets that encourage villages and communes to become “open defecation free” are needed.</p>
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To this end, the following must be developed: sanitation policy guidelines, a sector monitoring system, local implementation capacities, local private sector capacities and appropriate incentives, and financing arrangements, especially for reaching the poor.</p>
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Equally important, integration of sanitation interventions as part of broader national nutrition programs could offer important synergies.</p>
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We, as development partners, are ready to support the government with solutions that help to achieve better sanitation and nutritional outcomes for Cambodian families and children.</p>
Tue, 10 Dec 2013 09:00:00 -0500Alassane SowHow the Issue of “Going” Outside Hit Homehttp://blogs.worldbank.org/water/how-issue-going-outside-hit-home
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If a year ago you told me that I would be able to speak authoritatively on the technical aspects of sanitation, I would have thought you were crazy! Kenya is my home; I am 130% Kenyan and have lived here my whole life. In all this time, I never fully realized the sanitation issues in my country. True, I knew the statistics but until recently I didn’t fully realize how the impact was hitting my home.<br />
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<img alt="" src="https://blogs.worldbank.org/water/files/water/blog-going-outside-small-caption-s.jpg" style="float:left; height:296px; margin:5px; width:411px" />I was born in and currently live in Nairobi, the capital of Kenya and the most populous city in East Africa. Nairobi is the cosmopolitan hub of East Africa and bustling with activity both day and night. While I have always lived in the city, I have family who live in Migori, a rural village, roughly 600km from Nairobi and bordering Tanzania. &nbsp;As a child my parents would take us to visit every five years or so. Each time I was struck by the inconvenience and indignity of having nothing to use but a sheltered, smelly hole in the ground instead of a toilet. It required squatting, trying to aim to get it right in the hole and having to stay outside before returning to the house as I waited for the stench to wear off. We even came up with a way of making the stench that “stuck” on us less strong. We would remove cardigans and other heavy clothing before we entered the latrine (talk about innovation!). But each time I returned home from one of those visits, I quickly forgot what it meant to not have access to a clean, convenient toilet.<br />
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Recently, my supervisor suggested I join a team visiting several communities in different parts of rural Kenya to carry out research on rural sanitation practices. The focus group I was working on was trying to better understand the needs and wants of the community in terms of latrines for purchase. The communities all have high rates of people practicing open defecation, which has serious health and economic implications.<br />
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When we asked about latrines, we heard about the need for it to be clean, odorless, long-lasting, and all-weather (some latrines collapse during rainy season). One overarching theme the women mentioned was how a latrine would allow them to feel safer. As these women and anyone working in the sector will tell you, one major issue about not having access to sanitation is safety, particularly the threat of rape for women. Another safety issue that a Masai woman in a village in Rift Valley raised was the threat from animals. She told a harrowing story of how when she went outside at night to defecate in the open she suddenly found herself face-to-face with a hyena. At that moment, of course, the need to go ceased but it also made her decide to build a latrine within her homestead and so she is now one of the few latrine owners in the area. For men, there are also gender-specific implications of not having a latrine. They reported that not being able to provide a toilet for the family means losing respect among peers.<br />
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In Nyanza Karachuonyo, a rural area 400km from Nairobi, the villagers are defecating in Lake Victoria, which is the very same lake that the fish they eat are from, and the water they use for domestic purposes is from. Open defecation is a practice they have always known so I also learned that this isn’t just about providing a latrine. It’s about understanding current practices to better learn how to change behaviors.<br />
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So while I still remember when a toilet was just a toilet to me, it’s now so much more. I will no longer visit my family in Migori and take for granted the importance and convenience of having a toilet. Now, I find myself looking at latrine slabs, super structure, shape and smell – and not just looking, but taking photos!<br />
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Thu, 12 Sep 2013 16:54:00 -0400Jecinter HezronWhat's a Toilet Worth?http://blogs.worldbank.org/water/tapping-markets-and-creating-sustainable-water-and-sanitation-services
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<img alt="" src="http://www.worldwaterweek.org/templates/www/images/LogotypeWWW_2013.gif" style="float:left; height:82px; margin:5px; width:214px" />Did you know that, when you go shopping, you are acting as a Budget-Constrained Utility Maximizer? Or, in common parlance, you are trying to maximize your happiness, welfare or living standard with the cash you have in your pocket.</p>
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Should we act any differently as groups of individuals, in other words, trying to maximize collective welfare using available funds? Barring some exceptions, the answer for most public programs is that we should indeed try to maximize the welfare returns based on a limited budget. So in the public sphere as well as the private, we need to frame the discourse in terms of what returns we are getting from our spending, or what is the “bang for the buck.”<br />
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Of course, trying to maximize collective welfare from tax dollars has many challenges. How do you define welfare? How do you practically measure it? How do you deal with distributional issues, when programs benefit some but not others? While these challenges are undeniably present, we should not however avoid trying to compare costs with returns to inform key public decisions.<br />
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In a <a href="http://blogs.worldbank.org/water/what-costs-the-world-260-billion-each-year" rel="nofollow">previous blog</a>, I cited a study that claims <a href="http://www.worldbank.org/en/news/feature/2013/08/30/whats-a-toilet-worth-infographic" rel="nofollow">the health and time-loss impacts of inadequate water and sanitation are valued at least US$ 260 billion per year</a>, the equivalent of 1.5% of the combined GDP of developing countries. I went on to highlight new evidence that indicates sanitation interventions generate an economic return of 5.5 times (globally) with many <a href="http://www.wsp.org/esi" rel="nofollow">country case studies</a> demonstrating simple sanitation solutions in rural areas have economic returns of upward of 7 times. By any investment standard, these promised returns are gigantic. However, the catch is that a large share of these returns are social and long-term gains for the beneficiary, but not necessarily cash in the pocket in the very short-term, which would help them pay for the investment.<br />
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On the other hand, these quoted returns are underestimates. While the cost side of the equation is generally complete, the benefits are significantly undervalued, as there are many environmental and larger-scale, economy-wide effects that are not captured. A new study, being launched at World Water Week in Stockholm in September 2013, attempts to monetize broader benefits of reducing surface freshwater pollution in West Java, Indonesia. Furthermore, some of the key reasons why people might invest in a toilet, such as privacy, dignity, social status and physical security, are very hard to quantify, let alone monetize.<br />
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Hence, decision makers need to be made more aware of the returns to sanitation. And once they are aware and convinced, they need to be able to compare different sanitation options in terms of the relative costs and benefits. If they want to do this, where can they go? If they can only access global studies, or studies from other countries or contexts, they may remain unconvinced of the recommended solution. Ideally then, they will conduct their own welfare analysis, comparing costs and benefits, as part of the regular budgeting and planning processes. But how many of these exercises draw on robust data and utilize appropriate economic methodologies? Probably very few in the developing world (even in the developed world, proper cost-benefit analyses are rarely conducted, compared to the number of resource allocation decisions that are made).<br />
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For this reason, the WSP has developed an “Economics Toolkit” – an Excel-based software that enables any decision maker – whether a bank, donor or government – to make simple but evidence-based assessments of the economic impacts of inadequate sanitation, the comparative benefits and costs of interventions, as well as assessing the business case for a private provider to enter the sanitation market. The Toolkit has undergone extensive testing in three countries with the support of five summer interns (see Daniel Zonenschein’s <a href="http://csi.gsb.stanford.edu/economics-sanitation-initiative" rel="nofollow">blog</a> from Stanford University), and will be completed by the end of 2013 for wider application (check <a href="http://www.wsp.org/esi" rel="nofollow">WSP website</a>). While a tool is not a magic bullet, it will be a major achievement if it gets decision makers at all levels to discuss more openly the key role of improved sanitation in people’s lives, and think rationally (and critically) about the type of sanitation solutions that are locally appropriate, affordable and sustainable.</p>
Sun, 01 Sep 2013 12:42:00 -0400Guy HuttonEnding Open Defecation, Not by Evidence Alonehttp://blogs.worldbank.org/water/ending-open-defecation-not-by-evidence-alone
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<img align="left" alt="" height="182" hspace="5" src="http://blogs.worldbank.org/water/files/water/images/blog-ending-open-defecation-thumb.jpg" vspace="5" width="250" />Open defecation – going outside without using a toilet or latrine – is one of the most important threats to child health and human capital, period; ending it must be a policy priority.</p>
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Do you believe us?&nbsp; You should.&nbsp; A diverse, rigorous range of evidence is accumulating, indicating that open defecation kills infants and stunts the growth of young bodies and minds.&nbsp; New research in biology, medicine, and economics is coming together to resolve old puzzles and to document solutions.</p>
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Whether or not you will believe us could be another matter.&nbsp; Evidence alone is rarely enough to attract attention to overlooked causes or to ensure decision-makers select the right solutions.&nbsp; That is where partnerships between governments, researchers like Dean, and programs like WSP, the World Bank’s multidonor partnership program to increase water and sanitation access for the poor, come in – partnerships that can translate evidence into persuasive and useful knowledge that makes for better policy.&nbsp;</p>
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<strong>The evidence: Sanitation, stunting, and child health</strong></p>
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Over a billion people worldwide defecate in the open.&nbsp; This amounts to almost one in five people in developing countries not using any toilet or latrine.&nbsp;</p>
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We’re making a big mess.&nbsp; But beyond the ick factor, feces are full of germs.&nbsp; This means that widespread open defecation fills the environment that surrounds children’s homes with ready sources of disease.&nbsp; These germs accumulate in children’s intestines.&nbsp; Not only do fecal germs cause diarrhea, research now points to the greater importance of chronic intestinal disease.&nbsp; Such disease causes changes in the lining of children’s intestines that make it harder for the body to use the nutrients that children eat – even without necessarily manifesting as diarrhea.&nbsp;</p>
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Because early-life development is such a critical period, any net nutritional deprivation keeps children from growing to their bodies’ potential heights.&nbsp; And because the same health and nutrition that help bodies grow tall help brains grow smart, this analysis suggests children exposed to open defecation in the environment do not reach their cognitive potentials, either.&nbsp; This leads to an adult workforce that is less economically productive and less healthy – all for lack of putting feces in a safe place.</p>
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Height is an important indicator of a child’s well-being.&nbsp; Surprisingly, researchers have long been puzzled by the fact that average height differences across developing countries are not well explained by differences in income.&nbsp;&nbsp; For example, the average person in India is wealthier than the average person in Africa, but Indians are shorter on average.&nbsp; Moreover, this difference cannot be due to genetic factors.</p>
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A Policy Research <a href="http://econ.worldbank.org/external/default/main?pagePK=64165259&amp;piPK=64165421&amp;theSitePK=469372&amp;menuPK=64166093&amp;entityID=000158349_20130205082533" target="_blank">Working Paper</a> by Dean offers open defecation as an explanation.&nbsp; The paper considers several angles, but the key message is found in the figure shown.&nbsp; Each circle represents one county in one year; in fact, they are collapsed rounds of USAID’s Demographic and Health Surveys.&nbsp; The vertical axis is an indicator of the average height of children under three; the horizontal axis measures children’s exposure to fecal germs: how many people openly defecate per square kilometer.</p>
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The downward trend is clear: countries where children are exposed to more fecal germs have shorter children.&nbsp; Indeed, open defecation per square kilometer can linearly explain 65% of all cross-country variation in child height in these data.&nbsp; Moreover, open defecation can statistically explain the puzzle of Indian stunting: with both poor sanitation and high population density, Indian children face a double threat.</p>
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<strong>The rest of the iceberg: Fluency and trust</strong></p>
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So, there is growing evidence that policy-makers concerned about children’s health and human capital should concentrate on reducing open defecation.&nbsp; But statistical evidence may not be enough to empower policy change – especially if it sits in academic journals.</p>
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The World Bank Group’s global reach allows us, through the range of our financial and knowledge products, to help deliver these important messages from academic research in a timely and intelligible fashion to policy makers, translating high level knowledge into practical solutions which are relevant for the development challenges that policy makers grapple with every day.&nbsp; Clever experiments from the psychology of persuasion and influence demonstrate that more than a good argument is needed to create change.&nbsp;</p>
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For example, people are often unimpressed by complex arguments.&nbsp; “Fluency” is the ease with which a text can be mentally processed.&nbsp; Arguments might be disfluent because they are written with unnecessarily big words, or merely because they are printed in a hard to read font.&nbsp; Psychologist Danny Oppenheimer found in an experiment that not only do readers given the same text written more complexly rate the “author” as less intelligent, light printing from a low toner cartridge can have the same effect.&nbsp; What is the connection?&nbsp; Both make a text harder to mentally process.</p>
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Oppenheimer won an Ig Nobel prize for documenting, as he puts it, the “consequences of erudite vernacular utilized irrespective of necessity.”&nbsp; But the problem is no joke.&nbsp; Researchers are trained to speak precisely in technical language.&nbsp; For people like Dean, speaking econometrics is actually easier than talking normally – running the risk of missing the chance of delivering an important message in the brief meetings covering many topics with senior policy makers.&nbsp; People often talk about “translating” research into policy; sometimes the translation is literal.</p>
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Further, many researchers build a career by publishing many papers on a range of topics.&nbsp; Professionally, they have little incentive to maintain relationships with one department’s ministers and secretaries who will cycle onto other jobs next year.&nbsp; However, research shows that people are persuaded by those we like and trust – especially those with whom we have developed relationships.&nbsp; It is no accident that Danny Oppenheimer, remembered and mentioned above, is Dean’s former psychology teacher.</p>
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These are ties that organizations like the World Bank Group, and programs like like WSP can build and maintain.&nbsp; However, for such an organization to be trusted, it cannot offer only glitzy persuasion: it must build a history of responsibly selecting the right arguments to advance.&nbsp; Finally, no statistical argument can fully substitute for the practical wisdom of years of practical experience, which we can integrate with the latest research. Practical experience, gained on the ground with government officials of all ranks, not only serves to ensure that the World Bank Group understands the issues, it builds confidence that we will be there for the implementation.</p>
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<strong>Impactful evaluations?</strong></p>
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More than ever, development economics research is concerned with clear statistical demonstrations of cause and effect.&nbsp; Development organizations are encouraged to conduct “impact evaluations” – often in partnership with academic researchers.</p>
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It is important to think carefully about the impact of impact evaluations.&nbsp; We are far from the first to observe that even the best evaluations will have little impact if trusted partners and peers do not make them accessible to policy-makers. Impact evaluation is neither an evaluation of the people implementing a program, nor need it be an assessment of value for money, but rather an additional benefit for all concerned to help shape future activities. Like many organizations these days, we are learning the value of knowledge brokers and evidence producers working together.&nbsp; And as we learn together, we will be spreading urgent knowledge of the alarming consequences of widespread open defecation.<br />
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Wed, 03 Apr 2013 09:48:00 -0400Jaehyang SoWe Need Your Support to Get Our Dignity Backhttp://blogs.worldbank.org/water/help-we-need-your-support-to-get-our-dignity-back
<P><IMG height=180 alt="" hspace=0 src="http://blogs.worldbank.org/water/files/water/x_clts_latrine.jpg" width=135 align=left vspace=2 border=0>In 2007, when I started to work on <A href="http://www.wsp.org/scalingupsanitation">rural sanitation in Tanzania</A>,&nbsp; I was intrigued to see the plethora of reports highlighting the ‘sanitation crisis’ in Africa. Of all the Millennium Development Goals, Africa was performing worst in meeting the sanitation target. This message was repeated during the <A href="http://esa.un.org/iys/">International Year of Sanitation</A> and through the <EM><A href="http://www.commit4africa.org/content/africasan-2008-ministerial-statement-ethekwini-declaration">eThekwini Declaration and Commitments </A></EM>in 2008, at <A href="http://www.africasan3.com/">AfricaSan3 </A>in 2011, and in the WHO/Unicef Joint Monitoring Programme report on <A href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-report-2012-en.pdf">progress toward MDGs</A>&nbsp;released last month.&nbsp;But progress is slow.&nbsp;It’s time for us to engage with other groups and sectors that are affected by inadequate sanitation – health, education, environment, and finance.<!--break-->It’s not that we don’t know the problems--we’ve identified them through rigorous studies, country diagnostics, and client requests. Our mantra is Capacity Building, Policy, Strategy, Monitoring and Evaluation, Institutional Arrangements, Financing…yet we remain off-track. And worse, we’re slipping back as <A href="http://www.un.org/esa/population">Africa’s population increases</A>.</P>
<P>Sanitation is intrinsically linked to poverty reduction.&nbsp; It doesn’t take great analytical skills to work out that lack of sanitation affects the poor by an order of magnitude so great that it’s shameful. As <A href="http://www.unicef.org/media/media_41901.html">Ban Ki-moon noted </A>“Access to sanitation is deeply connected to virtually all the Millennium Development Goals, in particular those involving the environment, education, gender equality, the reduction of child mortality and poverty.”&nbsp;African countries lose more money per annum from the economic impacts of poor sanitation (<A href="http://www.wsp.org/wsp/content/economic-impacts-sanitation">see latest research</A>) then it would cost to eliminate open defecation. <A href="http://www.wsp.org/wsp/sites/wsp.org/files/publications/WSP-ESI-Nigeria-brochure.pdf">Nigeria </A>alone loses US$1 billion per year to the impacts from open defecation – yet eliminating the practice would require less than 6.5 million latrines to be built and used!</P>
<P>Those of us who work&nbsp;in sanitation and have somewhere private, clean, and safe to defecate&nbsp;should feel the shame of open defecation. We look to you, our partners and potential partners from other sectors, to innovate with us and move towards a more rapid scaling up of access to basic sanitation on this continent.</P>
<P><EM>Image: Improved sanitation in rural Mozambique (c) Luis Macario</EM></P>Tue, 17 Apr 2012 09:16:43 -0400Yolande Coombes